Open AccessReduced door‐to‐balloon times in acute ST‐elevation myocardial infarction patients undergoing primary percutaneous coronary intervention
Author(s) -
Wang Y.C.,
Lo P.H.,
Chang S.S.,
Lin J.J.,
Wang H.J.,
Chang C.P.,
Hsieh L.C.,
Chen Y.P.,
Chen W.K.,
Chen C.H.,
Chang K.C.,
Hung J.S.
Publication year - 2012
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/j.1742-1241.2011.02775.x
Subject(s) - medicine , conventional pci , door to balloon , percutaneous coronary intervention , myocardial infarction , emergency department , interim , cardiology , st elevation , cardiac catheterization , emergency medicine , cath lab , archaeology , psychiatry , history
Summary Background: Primary percutaneous coronary intervention (PCI) in patients with ST‐elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity, particularly when door‐to‐balloon (D2B) time is < 90 min. We sought to minimize preventable delays by instituting an on‐site cardiology team‐based approach in the emergency department (ED). Methods: The on‐site group comprised 146 consecutive patients with STEMI undergoing primary PCI after implementation of the on‐site strategy. This new patient care model was compared with the conventional care administered before instituting the on‐site cardiology team‐based strategy in ED, which included 90 patients (interim group) receiving primary PCI at a catheterization room in the same building as the ED, and 147 patients (pre‐on‐site group) undergoing primary PCI at a catheterization room two blocks away from the ED. Results: Median D2B time decreased from 107 min in the pre‐on‐site group to 72 min in the interim group, and to 47 min in the on‐site group, respectively (p < 0.001). The percentage of D2B times < 90 min increased from 34% to 78% and 96%, respectively among the three groups (p < 0.001). Hospitalization costs were significantly reduced in the on‐site and interim vs. pre‐on‐site groups ($5944, $5999, and $6581, respectively; p = 0.008). In‐hospital mortality did not differ significantly among the three groups (4.8%, 2.2%, and 6.1%, respectively; p = 0.387). Conclusions: Institution of an on‐site cardiology team‐based approach in the ED significantly reduces D2B time in STEMI patients eligible for primary PCI.